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Beatrix Hoffman Education. (2012) 'Health Care for Some Rights and Rationing in the United States Since 1930.'

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U.s. 20, United States 10, Chicago 9, Florence Greenberg 7, Jefferson 7, America 7, Texas 4, Beatrix Hoffman 3, Geraldine Smith 3, Greenberg 3, Us 3, Dr. Hoffman 2, Eleanor Roosevelt 2, Israel 2, Germany 2, France 2, Britain 2, Un 2, Natalia 1, The City 1,
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  CSPAN    Book TV    Beatrix Hoffman  Education.  (2012) 'Health Care for  
   Some Rights and Rationing in the United States Since 1930.'  

    November 11, 2012
    11:00 - 12:00pm EST  

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would have legitimacy with the opposition back in syria itself. but there are some attempts and people are thinking about these things-perhaps because of what happened in iraq in 2003. >> wonderful. one more. yes, please. >> what this likelihood that the regime will use chemical weapons and what should we or could we do if they do? >> good question. that's one of the questions that no one has an answer, understand what circumstances would the regime use chemical weapons. i suspect they don't want to use them because that would galvanize the exact international response they're trying to avoid. the don't want this type of mass blood-letting that will compel the international community to intervene much more assertively than it has. so i don't think they're going to use chemical weapons. the fear is, though, if the regime -- if the opposition gains the upper hand, if the regime is on its last legs will
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they want to go down in flames or will they want to launch a chemical attack against israel, for instance, desperately trying to turn a domestic conflict into an arab israeli war that will take the pressure off them for a little bit, coe aless the people around israel and soing for. that's the dooms day scenario. >> wonderful, thank you so much for being here. [applause] >> i would like to invite you to >> this event took place at the 17th annual texas book festival in austin, texas. for more information about the festival visit texas festival.org. >> up next, beatrix hoffman presents a history of the american health care system.
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she present your thoughts on why the united states has been one of the few developed countries do not adopt universal health care. and examines where the issue is so divisive. this is just under an hour. >> hello, everyone. i'm dale davis. and a former faculty member of women's studies, women's history and so on, so i'm delighted to be here. and happy we are sponsoring this program. thank you to all of you, and thank you, gretchen, for the nice introduction. it's really going to be the best of all pleasures to introduce doctor beatrix hoffman to you. she is a leading historian of u.s. health care systems. i bet you have been very busy during this political season, beatrix, with the debate about what's best in health care,
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what's best in health care insurance, what's best for women's health care rights being in the air everywhere you look these days. so as a person addicted both the politics and in academic and women's history, i come and i'm sure all of us, are really looking forward to your presentation, so thanks for being here. you couldn't be any better town for this talk either. since much of grand rapids including grand valley state has been very highly invested in the health care industry, hoping to develop stellar health care education, research, innovation and practice are all on the quest for great health care. i hope some of the visitors to town will be able to see what we call health care in michigan where so much of investment in medical health related work has been made.
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doctor hoffman is professor and chair of the department of history at northern illinois. she completed her ph.d as it seems at the mit will did at rutgers university in 1996. she's written extensively on the history of american health care reform, including 2001 book entitled "the wages of sickness" that the university of north carolina first put out. and her talk today though, she's going to speak about her latest book. that the title is "health care for some." the talk is entitled health care for all, women activism and human rights to health. this is a history, her book, rather at today will be partly a
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history of rationing in the united states and the great depression to the present, and the book just came out this month by the university of chicago press. icy copies of flying around. by all accounts, dr. hoffman has simply nailed his big historical topic up to the present moment. i'm going to read a few blurbs from the early reviews of the book to keep you a sense of how that is being received. t.r. reid, is author of healing of america writes this, in the american political debate, everybody condemns the notion of rationing health care. but beatrix hoffman meticulous history shows that rationing by income, age, implement, et cetera, as the end remains a central element of america's medical system. she demonstrates that our various attempts at reform over the decades have kept the
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rationing mechanisms firmly in place. so i wonder do you think she'll talk about death panels, to? i don't know. jonathan oberlander was author of the political life of medicare rights this, excuse me, my allergies are showing up this morning. beatrice hoffmann skillfully chronicles america's struggles to make health care a right from the depression through obamacare. have beautifully written account explores the pervasive rationing of medical care and insurance and are staggering and equal health system. health care for some is a compelling reminder of how far we have come but also how far reform solicitor in the united states. the reviews keep this tone throughout. beautifully written, insightfully described, and thoroughly researched. this book is a must read.
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thank you so much for your work. and i know we are -- let me get out of the way and join me please in welcoming dr. hoffman to the stage. [applause] >> thank you so much for that really kind introduction. i'm honored, and again, i want to thank the conference organizers for inviting me to be here today. in july of 1938, the roosevelt administration organize a national conference on health care reform. the great depression had been going on for nearly a decade. fdr had signed the social security act and the fair labor standards act into law, but the united states so no national program for addressing the health needs of the people.
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the 1938 health conference was beginning of something different. instead of inviting only doctors to speak, the conference for the first time included members of labor unions, farm groups, and civil rights organizations. it included representatives not just of the medical profession, but of the people who needed and used health care. that summer a woman named florence greenberg traveled from chicago, illinois, to washington to offer her testimony. greenberger was a member of the women's auxiliary of the steelworkers organizing committee, spending her days working in the communities around chicago's steel mills. greenberg told the audience at the national health conference that should come to offer them a different picture of chicago.
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just steps away from the comfortable headquarters of the american medical association, was a chicago of dirt, filth and tenement. basic chicago where people struggle with terrible health conditions related to poverty and unemployment and struggle to obtain basic medical care. greenberg told the conference that the grossly over kenneth cook county hospital, the city's only public hospital which locals described as a death house. a single overcrowded private hospital served the entire african-american community of the southside. chicago's outpatient clinics were still to bursting. greenberg spoke of people who are too sick to leave their homes but couldn't get a doctor to visit them, or who couldn't afford the few pennies for transportation to a clinic. she told the audience about a child with double pneumonia who
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have died of an abscessed long, after being turned out of the hospital because the relief agency would no longer pay for her care. and on behalf of the working people of chicago, florence greenberg made the following demand. we're asking our government to take health from the list of luxuries to be bought only with money and add it to the list containing the inalienable rights of every citizen. you don't know whether franklin roosevelt ever heard about florence greenberg unprecedented call for health care as a right. because even though he had endorsed the conference, he chose that time to go on vacation. fdr was actually on a cruise. guess we can't really blame him. probably pretty well deserved vacation. but three years earlier, fdr had
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refused to include medical coverage as part of the social security act because he didn't want to to antagonize the american medical profession. he gets in a message of support to the health conference, but not long afterward the outbreak of world war ii force the president attention elsewhere. five years later on january 11, 1944, in his state of the union address, roosevelt spoke to the american people about the war, and especially about the kind of peace the allies planned to establish after the defeat of fascism. he said that the one supreme objective for the future can be summed up in one word, security. and that means that only physical security which provides safety from attacks by aggressors, it means also economic security and social security. the individual political rights upon which the united states had
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been built, roosevelt argued, were necessary but not sufficient to guarantee true freedom and to get a. fdr didn't announce an economic bill of rights which is sometimes called second bill of rights. that included the right to a job and a living wage, a right to housing, education, and security in old age, and a right to adequate medical care and the opportunity to achieve and enjoy good health. so even though fdr new steering florence greenberg's speech, we hear echoes of it in his second bill of rights. the idea of economic and social rights as essential supplement to political rights started as far back as the french revolution. but the idea of a right to medical care was something much more recent. discretion of this kind of right became prominent in the 1930s and '40s, first of all because medical care itself was becoming
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more effective. it was starting to matter much more. in everyone's lives. by the '40s, the public knew about medical miracles like vaccination, penicillin, antiseptic surgery, treatment that could save lives and even extend life. and to withhold these miracles came to seem unjust. medical care at this time is also starting to cost more than ever before. the average family could not afford to pay for hospital stay or major illness, or the birth of a child just out of their wages. the medical care had become not just a matter of life and health, it was also becoming something that could cause serious financial hardship. that is for medical care became a matter of economic security as well as health security. in the u.s., demand for medical
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care as a social right originated in the workers movement represented by people like florence greenberg. they next came to national prominence in fdr's proposed second bill of rights. and, finally, they were adopted in the united nations universal declaration of human rights after world war ii. thanks in part two of eleanor roosevelt who helped draft the u.n. declaration after her husband's death. today, more than 70 countries recognize a right to health or health care in their constitutions. virtually every industrialized nation can take a step to implement these rights via establishing some type of universal health coverage for their citizens. with one major exception. anybody know? the united states of america. but it's not for lack of trying.
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after fdr's death, president harry truman announced a national health insurance program that would've made medical coverage for all part of the social security act. but the physicians of the american medical association attacked truman's plan as socialized medicine. that might also sound familiar. and in the early cold war, the ama won that battle, and treatments proposal was defeated. other presidents including richard nixon and bill clinton tried the passing of universal health care programs, but they fail due to entrenched and vigorous opposition from not just the medical profession, but also opposition from the business and increasingly powerful insurance industry yo. health care reform in the u.s. was pronounced and possible. -- and possible.
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but then the possible happen. and today we have 2010 affordable care act, or obamacare, which everybody is calling it now. so does the passage of the affordable care act mean that when you have a right to health care? the answer is not really. there are some important victories for writing the law. the biggest one is the ban on insurance companies being able to exclude people from coverage because they have pre-existing health conditions. the affordable care act will also expand access to health coverage by providing federal subsidies for people who can't afford insurance on their own. but even when the law is fully implemented, if the law is fully implemented, there will still be a lot of people without health insurance, estimated to be up to 30 million remaining uninsured.
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and this number, this estimate became higher than originally projected because of the supreme court decision last summer, which will allow states to opt out of expanding medicaid. although the affordable care act creates a new right, they're still a universe right to medical care in america, with one major exception, and that is a right to be seen in an emergency room. which is something we've been hearing a lot about recently. but a right to emergency care is not the same thing, it's not a substitute for a system that takes care of people self and protects protects the economic security. so why, why is this the case? what has made the united states an outlier nation when it comes to the right to health care? i've been studying this question for a very long time, way back
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in the '90s. and i'm sorry to say, although office to ensure it won't be surprised to do this, there is no single answer. my book, "health care for some," tries to provide a few the answers i analyzing the history of this country's long tradition of unequal access to health care. for the next few minutes i'm going to talk about some of the book's arguments, and then i'll give a couple more examples of women activists who have challenged the american system of unequal access in the tradition of florence greenberg. so, the subtitle of this book is rights and rationing in the united states. i've already talked a bit about rights and how americans don't really have them when it comes to health care. and political argument you often hear that the u.s. may have a lot of problems with its health system, but at least we don't
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ration the way europeans and canadians do, as you have heard those. you may for the argument that universal health care means a government bureaucrat will deny your life-saving treatments in order to save money for the system your we still are some people insisting that reform will lead to a death penalty and during the first presidential debate, governor romney warned of an unelected board that will deny treatment under obamacare not only are these claims misleading at best, but they also imply that rationing or the denial of health care would be something new to our system. something extremely un-american. but i believe that the claim that the u.s. is not currently rationing health care has been counterproductive, damaging, and
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inaccurate. in my book uses historical evidence to show that the u.s. has ration health care for a long time. not the way europeans are canadians do two things like official waiting lists or cap on national health expenditure, but this country is allocated and deny health care in a complex and unique way that i call the american way of rationing. so what is the american way of rationing come and how can history help us understand it? in classical economics, rationing simply means the goods and services are distributed by price. in other words, that everybody can afford everything they could possibly want or need. so supply and demand are controlled i peoples ability to pay. rationing by price or rationing by the market certainly goes a long way to describe the u.s. health care delivery system. the government may not officially deny you health care,
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but many americans do not get the care they need because they can't afford it. in the u.s. health system into 1986, it was legal for hospitals to turn away patients simply because they could not pay. and that is still true in the case of non-emergency conditions. we have a huge number of studies showing that economic barriers lead to people not being able to stay in primary and preventive care and even lead to reduced life expectancies. so the u.s. rations health care based on the ability to pay. people without health insurance have more trouble getting care, or they don't get it at all with severe consequences for their health. but that is not the whole story of the american way of rationing. i showing my book at the u.s. has ration health care in many other ways, by race, by region or location, by type of
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insurance coverage, by health condition, by age, by miracle or parental status, by gender, and the list actually goes on. i'm going to give just a few examples from history of these various types of rationing, starting with race. you are probably all aware that a jim crow system existed in health care, as it did elsewhere in the south. but did you know that a separate and unequal hospital system was built and paid for with federal funding? the hill burton act of 1946 which allocated billions in federal dollars to expand u.s. hospital system after world war ii included a special provision allowing southern hospitals to separate black and white patients. there are cases on record of patients dying and women giving birth in a hospital parking lot
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because the segregated black section of the hospital was full even if there was room in the white section. in the north there was another kind of rationing by race. in chicago and many other northern cities, ambulances would take african-american emergency patients to the public hospital and even if a private hospital was much closer. and people died because of this practice. even after official discrimination was outlawed, other type of rationing i raise continued. or example, the slight of hospital some inner-city neighborhoods to mostly white suburbs. the u.s. health care system also rations by employment or job status. after the defeat of the true by national health plan in the '40s, instead universal health care we developed a system of private health insurance provided as a benefit of
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employment and supported by the federal tax code. and this is still how most americans get their health care today. health coverage. so insurance coverage in access to health care depends on what your employer, and where you are employed, whether your employer chooses or is able to provide health benefits, and what kind of how much of the cost of the employer is willing or able to cover. a system based on employer-based coverage excludes a lot of people. people who work for smaller employers and unemployed, women and temporarily leave the workforce to have children, the poor and the retired don't have access to insurance provided by an employer. rationing by employment means that people who retire lose health coverage at a time when they will probably start to need
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it the most. and it was this flaw in the employment-based health system that led, helped lead to the creation of medicare in 1965. but medicare itself is a system of rationing by age. there's no law to give all people over 65 a completely different kind of health coverage than people under 65, except that is the way the health system evolves. creating incremental programs to try to cover the gap, and we have another completely different system for the poor, medicaid, which rations by one of the most ancient methods of all, the means test, a test that determines if you're poor enough to be eligible for the program. how old you are, how poor you are, where you work and, of course, how much money you have.
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the answers to these questions determine what kind of health coverage and care are available to you in health care system, if any is available to you at all. so do we still think the u.s. doesn't ration? we have entirely separate health care systems for veterans and for native americans. we have public and private hospitals, doctors accept medicaid or to refuse medicaid, doctors and hospitals that are in a network or out of your network. access to care that is based not on how sick you are but how much insurance you have, the right to care in an emergency room but nonot in the doctor's office. people getting too much medical care and people unable to see a doctor at all. the american way of rationing is complicated your it's confusing and is very irrational. and when you add it all up, this
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kind of rushing leads to a system that is the most expensive in the world. in the u.s., we spent over $8000 per person on health care each year. nearly twice as much as canada and germany. more than twice as much as britain and japan. rationing is supposed to lead to lower costs. -- [inaudible] all of our spending still leaves millions without health coverage. does the affordable care act
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continue, or does it disrupt the american way of rationing? i could say that does a little bit of both, but at 2500 pages, it actually does a lot of both. first of all, by requiring insurance congress to accept people with pre-existing conditions, obamnicare strikes a major blow against rationing by health condition. i don't think it's possible to overstate the significance of this, because it basically is telling insurance companies that they have to fundamentally change the way they do business. that their job is to cover sick people as well as healthy ones. imagine that. and that is a very big change for the american insurance industry. requiring everyone to buy health insurance or pay a fine, the individual mandate is not exactly are right. it's more of an obligation. but offering federal subsidies to people who otherwise couldn't
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afford insurance goes some way toward alleviating rationing of coverage by ability to pay. a lot will also reduce rationing on the basis of gender, which i will talk more about in a little while. there are many important provisions in the act that will help balance toward more preventive care and greater access to primary care. but there are also many ways that things will remain the sa same. the affordable care act as i said earlier does not create universal coverage. and it builds upon and leaves fairly intact a multi-tiered unequal health system of private insurance, public insurance, different insurance for the middle-class and poor, for the employed and unemployed, the young and the old, et cetera. i don't mean to dismiss the achievement of this reform. it is historic, and it certainly
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brings us closer to universal coverage than anything we've had before, but it doesn't change the system fundamental nature of separating people into many different categories in a way that is inefficient, very expensive, and in many ways unjust. aske..
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in the time remaining in the attack but to other women there natalia century who refuse to except the american way of rationing and tick is denim behalf of health care as a ride. so are going to a jump ahead three decades ago after florence greenberg speech after the passage of medicare and medicaid to september of 1971 the american novel association held its annual meeting in houston texas. the american hospital
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association, you may have heard of them. they're like the ama for hospitals. not as well-known as the ama, but the very powerful lobbying group on behalf of the interest of private hospitals in the u.s. for over a century. the 1970 meeting turned out to be unlike any they ever had before. the hospital delegates were greeted by picket line of mostly african american women and children who were carrying signs and chanting, saying things like to make equal treatment for medicaid patients and hospital care for the poor. these pictures represent the national welfare rights organization, a grass-roots group of thousands of welfare recipients or welfare mothers as there were sometimes called and sometimes called themselves than as well. this meeting of the hospital
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association in 1970 was the first major action the welfare rights movement campaign to stop discrimination against the poor in the health care system. the welfare mothers demanded to speak to the convention and eventually they're request was granted. freeman and geraldine smith who was the national welfare financial secretary got up in front of the convention and made an absolutely blistering speech. she told the audience of hospital lobbyists that the american hospital association is hit -- hypocritical, selfish, parochial, and patronizing and that hospitals hide behind a screen of concern for the disadvantaged of perpetuating an unequal system of health care. then presented the delegates with a list of demands from the welfare rights movement. she told hospital officials to
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end the practice of dumping poor and uninsured patients are transferring them and unstable condition. she demanded the establishment of clinics so people could attend, instead of going to the emergency room. she called for a requirement for all hospitals to accept medicaid patients in demanded that patient representatives and members of the community, especially representatives of the poor should have seats on hospital boards. she asked for informed consent about medical treatment and especially that all patients should be treated with dignity and respect. supposedly the audience of hospital officials listened very politely to all this, but once that was finished speaking they went about their business at the convention as if nothing happened. but shortly after this meeting, the american hospital association began drafting the first patient's bill of rights, which was eventually adopted by house bills all over the country
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and included a crucial rite that geraldine smith had mentioned, such as the right for patients to have informed consent. hospitals also began around this time to include community representatives on the governing board. as you might imagine, the age a bill of rights did not resemble what the welfare rights bill of rights will look like. it did not include any of the rights to access to health care that geraldine smith had demanded, and these bills certainly did not recognize a right to health care. they did represent a turning point to other voices of patients could no longer be ignored. the welfare mothers invasion of the hospital meeting in 1970 but the language of patients' rights into the mainstream health system for the first time. and my second example to its really well with last night's
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keynote address because she was an activist from detroit. her name is olga mannar, and she started working in auto plants in the 1930's and became the first female member of the executive board of the united autoworkers. in the 70's she was one of the co-founders of the coalition of labor union women, and she became its president in 1974. as president, she led the first national campaign against discrimination against women by the private health insurance industry. in a speech that was reported in these papers around the country, she enough that insurance companies were charging women premiums as much as 150% higher than man. insurance justified this practice by arguing that women have higher health costs. they describe us as plunkers,
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like old cars. we break down. we are unreliable, how to defraud and bankruptcy insurance industry. pointed out that as well as charging women higher premiums demand turns companies refuse to cover pregnancy and childbirth or offered only minimal coverage at very high expense. because of the concept of moral hazard, pregnancy and childbirth were considered to be an insurable conditions because women supposedly plan in advance . you're not supposed to buy health insurance knowing they are going to use it. that is really what they said. some companies covered maternity, some companies did cover maternity, but only for the wives of male employees. female workers were denied coverage. comprehensive coverage of maternity services in the 1970's , as late as the 1970's was virtually nonexistent.
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the activism against gender bias and health insurance helped lead to the passage of the pregnancy discrimination act of 1978, which required a large employers doing good maternity coverage in their health plan. but like all health reforms in the u.s., these new rights only help some of the population. the small group and individual health insurance markets, which were the only options for people not working for large employers continued to blatantly discriminate against women. until 2012, until this year a majority of individual health insurance plans charge women more than men, a practice called gender rating. and most of these plans even charge women nonsmokers more than male smokers.
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and the majority of individual insurance plans through this year still excluded maternity coverage. but this year important provisions of the affordable care act took effect that will ban many types of gender discrimination in the insurance market. the law does not stop such discrimination entirely. abortion services are placed in a special category, and states can ban abortion coverage altogether. but the law still contains many provisions that seek to end rationing by gender. all new health care plans will be required to charge men and women equally and to include coverage for maternity care. in addition, since august the first of this year the obamacare requires all health plans to cover without co-payments, many preventive and screening services for women, including mammograms, pap smears, prenatal
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care like patient support, domestic violence screen, and contraception. the coverage expansion's alongside the definitive end of generating and the ban on excluding pre-existing conditions are the most truly historic aspects of the new law. there will make the greatest inroads against the american way of rationing. but we also have to ask why it took so long to get your and why it was so difficult, blatant gender discrimination through -- that survived until 2012, 100 years after aggressive team of reformers called for equal treatment of maternity in health insurance. and as you all know, we face an election in which one party vows to repeal even those modest gains for quality in health coverage. the fight for health security in the united states is far from
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over. while all other affluent nations agreed long ago that basic health care should be the right of all citizens, the u.s. continues to treat medical care as a product to be purchased in the marketplace. even now the most sweeping reform in our history embodies this tension between the rights of the people and the rights of private companies and individuals to profit from the health care system. the three women i described in the stock lived at different times are in different parts of the country. it did not know each other and never heard of each other. but what all three of them have in common was their belief that ordinary citizens could take the lead in preventing a new vision of what our health care system could be. i think that all three of them would hope that the affordable care act, despite its flaws, would lead to a continuing and
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open participatory national debate about how the american health care system can best serve the needs of all the people. thank you for listening. [applause] >> we have time for questions. the way we would like to do this is beatrice will stay up there and i will come around the microphone and all that for anyone who has a question. if people start putting a pair hands as you have questions, i will come and find you. >> that definitive.
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>> thank you very much for a wonderful talk. i purchased your book. have look forward to reading it. i am a recent dean of brokers college of interdisciplinary studies which women and gender studies is in my program. my college, so i'm very happy to be here. i am very interested in the idea of human rights. have read the book my, roosevelts role, the riding of the universal declaration of human rights. i am wondering to what extent philosophical debates have played a role in the politics of the united states. i would expect pro a not very much. united states is born out of the philosophy, political philosophy of our country, born out of the enlightenment values endowed by
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our creators with basic rights, the pursuit of happiness, the liberty and freedom. and this was always at odds with the economic and cultural rights i am wondering to what extent in the debates have occurred in our history about what is a human right verses may be other kinds of civil rights or economic rights known -- a problem that the right to health care is not seen as a human right, you know, transcending what governments may or may not do. >> thank you for defining human rights. human rights are intended to transcend citizenship, national borders, except. and it is true that the united states takes a different approach, especially to economic and social rights as human
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rights. so i'm glad you've read that book about eleanor roosevelt and the un declaration. i was actually surprised at how strongly she advocated for the inclusion of social rights and they even declaration. i had expected the u.s. stance to be much more focused on individual rights, while we would also consider-rights, freedom from oppression, freedom from control by the state, eccentric. both roosevelts were actually crucial, including the social rights and the un declaration. but that didn't resonate here. it did not resonate, and there were also organized groups that worked to oppose the acceptance of such rights. the medical profession on certain business groups.
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there was a specific campaign to prevent the u.s. from excepting the economic and social rights in the 90's. that was run by a conservative group. so i think their is a lot of ideological resistance to a social rights. there is also an organized political resistance to them. the book has combined to make less than for ground for social rights as human rights and the u.s. >> my question to you almost ends up, individual health care, which i grew up in germany, so it's very hard to understand. family members of chronic illnesses, why they are opposed to health care that would help them. so that is the individual level
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among americans. was wondering if you could talk more about that. >> well, correct me if i'm wrong several other european countries, there is a principle of solidarity. but where that rings true. and that has been very explicit in their political culture and is widely expected even, i think, among conservative people that when it comes to things like health, things that people have no control over, the principle of social solidarity tech's president and so people pay severance covered. it is true that individuals, a very strong force against the exceptions of that solidarity. important to know about the concept of solidary because a little bit more nuanced arguments about all they do over there is socialism because there
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is a spectrum. solidarity is a very mainstream concept in europe and my belief. but individualism needs to, you know, you might see the neighbor suffering, but maybe it's their fault. maybe they're not eating right or not exercising or have done something. and this is, i think, an example of the way individualism can shape the health care debate in the country. and that kind of takes form in the individual mandate of the affordable care act which is not , again, an admission of solidarity or that we are all in this together. its individual responsibility and obligation to purchase health insurance. >> ceo of health services, federal qualified health center.
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a country of about 310 million people. out of that, until very recently about 55 or 60 million of those people did not have coverage. with the affordable care act that number will be down to about 30 million people are so, and if we fully implement the affordable care act, that is, if all states choose to have the additional medicaid coverage, we could be down to about 59 who don't have coverage. that extension of medicaid comes at very low cost to the states involved. the system is already set up in the affordable care act to go into effect in to cover those costs. if the states' use to move ahead with that. i find it inconceivable that we
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could deny 15 million more people coverage. and i also find it incredible that we are able to deceive people so much as to try to encourage them not to cover the additional people. see you have any comments on that are out of my workout? >> medicaid expansion, i do, and i would also like to talk for a second of a community health centers. so affordable care act was intended, as you said, to pretty drastically reduce the number of uninsured and the country through two different mechanisms. so instead of covering everybody which test of -- has a brings images to mind of a sweeping coverage. you have coverage. covers the people lori have been in there will be a segment of the uninsured who are not poor enough to qualify for medicaid, so they will be subject to the
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individual mandate with subsidies to help them buy it. and for the poor and up to 133% above the poverty level, which is a significant rise in the requirement for medicaid, covered by this expansion. but as i mentioned, the expansion was not upheld by the supreme court last summer, so even though states can go ahead with it in a lot, as you said, states are now able to opt out of it, and several of them have already done so, texas being one of them. we don't want this money, even though it's free money periods mistakes in the federal government, so they're saying, the states that are refusing mr. saying, well, it's going to be too expensive in the long run , but it's hard to imagine that there is not some sort of ideological component to the refusal because it is kind of a
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no-brainer. it is a cheap way of covering a lot more people. and so now instead of -- and then to conclude that, i get there after these new types of coverage. so now we're going to have this, but then the medicaid coverage is going to go way down. so the gap is going to be at much bigger. and i did mention the provisions for community health centers and a lot. is your center going to be affected at all? there is a lot more money for these types of community based on its now. to you have anything to have? just curious how it is affecting you. >> our services considerably with a couple of new clinics, including one that is opening up monday. -- and so i think one of the other issues besides coverage is the fact that you can have a
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card, a medicaid card, for example, but if there aren't enough other places @booktv of places that except medicaid coverage you still don't get care. so this is a provision of the act that allows community health centers and other preventive oriented agencies to open their doors a little bit further so that you can use the coverage. >> great. thanks. >> we have time for one more question over here, and that just want to remind people that we have books for sale outside, and we have a next panel to get on to bury them going to come right up here from last question. >> i have a question about the women activists and let you just shows women activists because it's women engineers historians of the midwest or women in the vanguard of this kind of pushing back against what they perceive
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to be inequitable treatment and if so, why or why not. >> i guess they have. added that to the purpose. they came to me from the historical record. when i wrote my first book on the progressive era health reform at it expects to be writing a lot about teddy roosevelt, and he is in there, but it was these women, government workers and union organizers in new york city who were really starting their own community health clinic in new york, and it did not use the language of rights of the time, but they definitely talked in terms of universalism and that everybody should have access to care, not just those who are unionized, members of unions. so is there a gender component to that is their gender make them more on the vanguard? in some ways i think there are some connections. the maternity insurance issue has always been a big one, so i think a lot of these critiques
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of the american way of rationing have been routed in women's experience with health care and health care needs of women have. some maternity coverage, coverage care for children was the habit is behind this shepherd towner act in the 1920's, the public health act. and, of course, the movement for reproductive rights has, at times, i wish more attention were paid to this because it has done this, but we hear much less about hal reproductive rights activism is also about health care for all to offer everybody. there's so much focus on women are demanding these particular reproductive services. but i think that those types of activism, again, rooted in experiences have led to a really strong stand on behalf of universalism and health care rights, even though not all activists would define at the same way.
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pressure going to have to stop there. >> thank you so much. [applause] >> for more information visit the authors website. >> book tv will be live at the miami book fair international hell on the campus of miami-dade college of the november 17th and 18th weekend. we will bring you ten of their talks and channel discussions, seven of their interview segments, and your chance to participate with facebook, twitter, calls, and the males and keep an eye for live author chats throughout the weekend. featured authors include
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for a complete list of authors, visit booktv.org. >> what i discovered is that jefferson appears to be a man of contradictions, but when you do something rather simple, which is to put him on the timeline and examine all of that action -- actions in excellent product to of chronological order certain patterns emerged and thing simultaneously give more complicated boyle lot simpler. and we are actually dealing with to jefferson's. the young jefferson who was a fiery radical emancipationist and the older jefferson who really embraced slavery. the young jefferson, oddly enough, has really not been steady all that much. as a newly minted member of the house of burgesses he made a proposal to emancipates lives in virginia. he made on the slide, shielding his identity using relative to submit the bill, which is a good thing because is relative was
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denounced as an enemy of this country and the bill was summarily dismissed, but then later under his own name as the revolution approached jefferson floated a more explicit plant, one that actually might have changed the course of our history. if only the country would stop the slave trade, jefferson wrote , it could proceed to the enfranchisement of the slaves of we have, meaning that they would become citizens. and he wrote this in a document called the summary of our defense summary view of the rights of british america, which he also submitted to the house of burgesses and it was again, some barely rejected. that led to his being chosen to write the declaration of independence, where he denounced the slave trade in no uncertain terms, another clause that was struck because south carolina and georgia would not abide any restrictions on the slave trade. but after the war estranged thing began to happen to him.
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oddly enough, france is a key to understanding the transformation in jefferson. when we think of france we think of sally and james hemming said. we think of french food. jefferson is getting to know french architecture and wine, but he went over there on very important national business. he was there as our trade representative. we were desperate to for money. we of money. the u.s. out enormous debts to britain. on -- are most important export was a slave raise crop, tobacco, which brought in some $30 million a year. now, jefferson had one problem. the most important and influential friends he had scored among the french aristocrats or all abolitionists, and they could not understand how we had fought a war for universal liberty without freeing the slaves. they put him under tremendous pressure, and they kept asking him, when is america going to free the

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